National Public Health Institutes Are Vital Component of Global Health

When countries coordinate their public health programs in national public health institutes, the result is better leadership focus, more efficient use of funds, and improved healthcare delivery, say public health experts in a series of articles this month in international scientific and medical journals. National public health institutes will have a critical role in achievement of new global health initiatives, which depend for their success on strong national public health infrastructure.

In a commentary in the British Medical Journal, Jeffrey Koplan, MD, MPH, and colleagues make a compelling argument for providing donor funding directly to national governments to strengthen public health infrastructure. They note that the burgeoning aid community has created a chaotic situation in which low-resource countries are deluged with thousands of unconnected and uncoordinated vertical programs while “the national public health systems in these countries stagnate or dwindle.”

Dr. Koplan is vice president for academic health affairs at Emory University and director of the Emory Global Health Institute. In 2006 Dr. Koplan, along with Pekka Puska, MD, PhD, director of Finland's National Public Health Institute—KTL, and colleagues from 39 national public health institutes worldwide chartered the International Association of National Public Health Institutes (IANPHI) to support the development and strengthening of these institutes throughout the world. IANPHI now has 50 international members. (http://www.ianphi.org)

In 2006 the Bill and Melinda Gates Foundation awarded $20 million to Emory University and KTL to provide leadership for IANPHI. The association's mission is to strengthen existing national public health institutes and to create new ones by providing grants to support national priorities for development of public health infrastructure. IANPHI has awarded its first technical assistance grants to public health institutes in five nations and recently issued a request for proposals and letters of intent for a second group of projects. (http://www.ianphi.org/?action=juttu&ID=71&valittu=)

As the focus of national public health responsibilities, IANPHI’s member national public health institutes are logical sites for donor investment in public health infrastructure, says Dr. Koplan. National public health institutes (like the U.S. Centers for Disease Control and Prevention) allow countries, through their public health authorities, to recognize and address health challenges through population-based interventions. These institutes help countries set and implement their national public health priorities, respond to international regulations, develop facilities and recruit healthcare workers. They also can help ensure that donor funds from multiple groups are coordinated in order to meet a country's most pressing public health needs.

"Countries may receive aid from hundreds of different sources, including individuals, foundations and non-governmental organizations, directed to thousands of development projects," says Dr. Koplan. "National public health institutes need to be strengthened such that they have the capacity to better coordinate and prioritize critical projects, as well as assemble the appropriate individuals to address a challenging problem. Addressing antibiotic resistance, for instance, could require the skills of microbiologists, epidemiologists, statisticians, health educators, communicators and infectious disease specialists."

National public health institutes can be much more effective than simply investing in thousands of unconnected and uncoordinated programs, but they must be adequately funded, Dr. Koplan emphasizes in the British Medical Journal commentary:

"We propose that donors of funds for specific diseases and other health problems in nations with low resources allocate 10 percent of their donations to the development of infrastructure in the host country, with special consideration for national public health institutes. Mechanisms for auditing and evaluating programmes should then be applied to both the programmatic and infrastructural components of these grants."

In the October issue of Emerging Infectious Diseases, Dr. Guénaël Rodier from the World Health Organization and others note the importance of strong national public health institutes in implementation of the newly revised International Health Regulations, and the role of IANPHI in strengthening global health security and yielding benefits of disease control and prevention.

An additional article in the November 2007 issue of the South African Medical Journal describes the challenges and opportunities that national public health institutes in Africa face in performing and coordinating core public health functions. The authors make a strong case for the role of IANPHI in yielding sustained improvements in national public health capacity and ultimately improved health outcomes for the global community.